Chronic Midsubstance Patellar Tendon and Retinacular Rupture: Primary Repair Enhancement Using Bioinductive Implant Augmentation
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PROVIDER: S-EPMC10533941 | biostudies-literature | 2023 Aug
REPOSITORIES: biostudies-literature
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Project description:Quadriceps tendon autografts are an increasingly popular choice for anterior cruciate ligament (ACL) reconstruction, with decreased donor-site morbidity alongside good patient outcomes. Although harvesting of the tendon can be done in a minimally invasive fashion, this introduces some difficulty with visualization and consistency of graft sizing. The purpose of this Technical Note and video is to provide a method of quadriceps tendon autograft harvesting using the Quadriceps Tendon Harvest Guide System (QUADTRAC) in a single-bundle ACL reconstruction.
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Project description:In the setting of traumatic midsubstance patellar tendon ruptures in which the tissue is unable to be repaired end to end, surgical options are limited. We offer a technique using suture anchors for the native tendon reconstruction, allograft augmentation, and a bioinductive implant. Technique Video Video 1 Introduction (0-7 seconds). Author disclosures (8-12 seconds). With the patient in the supine position on the operating room table, a midline incision is made over the patellar tendon (13-41 seconds). The patellar tendon tissue must be examined to determine how the surgeon can repair it. As shown, the surgeon identifies the midsubstance tear and the proximal and distal remnants of the tissue. Two No. 5 FiberWires are placed in a running locking fashion in the proximal tissue fibers (42 seconds to 1 minute 7 seconds). These FiberWire sutures will be anchored into the proximal tibia. The surgeon slides the allograft tendon through the tunnel just created in the tibial tubercle (1 minute 8 seconds to 1 minute 37 seconds). Both the allograft limbs are brought up along the medial and lateral side of the patellar tendon. By use of a tonsil clamp, the graft is passed below the retinacular layer to the superior pole of the patella (1 minute 38 seconds to 1 minute 46 seconds). The allograft is slid under the retinacular layer and will exit at the superior pole of the patella. With the knee flexed to 30°, the allograft is tensioned down and 3 No. 5 FiberWire sutures are placed in a figure-of-8 fashion to help approximate the 2 graft ends (1 minute 47 seconds to 2 minutes 2 seconds). This step is critical because the augmentation protects the tendon repair. The surgeon should ensure that the allograft is secured. In preparation for the distal tendon tissue to be anchored into the inferior pole of the patella, 2 guide pins are placed in the inferior pole of the patella, separated by 20 mm (2 minutes 3 seconds to 3 minutes 6 seconds). The surgeon then reams over those guide pins, and the distal tendon tissue will be anchored in. The proximal patellar tendon leaflet is anchored in distally on the proximal tibia (3 minutes 7 seconds to 3 minutes 28 seconds). The proximal tendon is overlapping the distal tendon leaflet that is anchored into the inferior pole of the patella. The allograft augmentation is on the medial and lateral aspects of the tendon and is under the retinacular layer and is tied at the superior pole of the patella. The graft is placed over the midportion of the patellar tendon and sutured in with interrupted No. 1 Vicryl (3 minutes 29 seconds to 3 minutes 39 seconds).
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Project description:Patellar tendon ruptures can lead to significant functional deficiency of the extensor mechanism of the knee. These injuries, because of their inherent nature and associated complications, may require a complex treatment and remains a challenge for orthopaedic surgeons. Current surgical techniques present significant complications, including patellar fracture, damage to patellar articular cartilage, and abnormal patella height. This note describes a surgical technique to provide an additional reinforcement to the patellar tendon repair with a semitendinous autograft, without the necessity to perform any transosseous tunnels at the patella bone. First, the patellar tendon is repaired with an end-to-end technique and the semitendinous tendon is harvested. A transosseous tunnel at the tibial tubercle is drilled and 2 rents are made, both medial and lateral to the retinaculum at the level of the intermedial segment of the patella close to the patellar margin. The graft is passed through the tunnel and rents in a U-shaped form. The graft is sutured along the length of the patellar tendon on both margins in tension at 30° of knee flexion. Fluoroscopy imaging is performed to assess the patella height. This technique provides a significant augmentation of patellar tendon, avoiding the potential patella bone tunnel complications.
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Project description:Ruptures of the patellar tendon are rare but potentially devastating injuries reported to occur most commonly in active males in their third and fourth decades of life. Repair failure rates have been reported to range between 2% and 50% based on surgical technique used. There are several inherent challenges associated with revision patellar tendon repair, including quadriceps atrophy, contracture, tissue loss, excessive scarring, and improper patella height. There remains no consensus regarding ideal revision patellar tendon repair technique. The purpose of this Technical Note is to describe our preferred method for revision patellar tendon repair using suture anchors and allograft augmentation with adjustable loop suspensory fixation. On the basis of recent studies, we have carefully chosen our fixation and augmentation methods that have shown biomechanical promise, while allowing the surgeon to carefully titrate the patellar tendon length and accommodate for some patellar tendon tissue loss.
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